Individual
GARY SWANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1080 N ELLINGTON PKWY, LEWISBURG, TN 37091-2227
(904) 805-1300
(904) 805-1302
Mailing address
PO BOX 532734, ATLANTA, GA 30353-2734
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD011234
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3170903
—
TN
01
—
4098059
BLUE CROSS
TN
01
—
P0020390
RRMCR
TN
Enumeration date
06/02/2006
Last updated
01/07/2008
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